Neuraxial anaesthesia for lower-limb revascularization.

BACKGROUND: Lower-limb revascularization is a surgical procedure that is performed to restore an adequate blood supply to the limbs. Lower-limb revascularization surgery is used to reduce pain and sometimes to improve lower-limb function. Neuraxial anaesthesia is an anaesthetic technique that uses local anaesthetics next to the spinal cord to block nerve function. Neuraxial anaesthesia may lead to improved survival. This systematic review was originally published in 2010 and was first updated in 2011 and again in 2013. OBJECTIVES: To determine the rates of death and major complications associated with spinal and epidural anaesthesia as compared with other types of anaesthesia for lower-limb revascularization in patients aged 18 years or older who are affected by obstruction of lower-limb vessels. SEARCH METHODS: The original review was published in 2010 and was based on a search until June 2008. In 2011 we reran the search until February 2011 and updated the review. For this second updated version of the review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, CINAHL and Web of Science from 2011 to April 2013. SELECTION CRITERIA: We included randomized controlled trials comparing neuraxial anaesthesia (spinal or epidural anaesthesia) versus other types of anaesthesia in adults (18 years or older) with arterial vascular obstruction undergoing lower-limb revascularization surgery. DATA COLLECTION AND ANALYSIS: Two review authors independently performed data extraction and assessed trial quality. We pooled the data on mortality, myocardial infarction, lower-limb amputation and pneumonia. We summarized dichotomous data as odds ratio (OR) with 95% confidence interval (CI) using a random-effects model. MAIN RESULTS: In this updated version of the review, we found no new studies that met our inclusion criteria. We included in this review four studies that compared neuraxial anaesthesia with general anaesthesia. The total number of participants was 696, of whom 417 were allocated to neuraxial anaesthesia and 279 to general anaesthesia. Participants allocated to neuraxial anaesthesia had a mean age of 67 years, and 59% were men. Participants allocated to general anaesthesia had a mean age of 67 years, and 66% were men. Four studies had an unclear risk of bias. No difference was observed between participants allocated to neuraxial or general anaesthesia in mortality rate (OR 0.89, 95% CI 0.38 to 2.07; 696 participants; four trials), myocardial infarction (OR 1.23, 95% CI 0.56 to 2.70; 696 participants; four trials), and lower-limb amputation (OR 0.84, 95% CI 0.38 to 1.84; 465 participants; three trials). Pneumonia was less common after neuraxial anaesthesia than after general anaesthesia (OR 0.37, 95% CI 0.15 to 0.89; 201 participants; two trials). Evidence was insufficient for cerebral stroke, duration of hospital stay, postoperative cognitive dysfunction, complications in the anaesthetic recovery room and transfusion requirements. No data described nerve dysfunction, postoperative wound infection, patient satisfaction, postoperative pain score, claudication distance and pain at rest. AUTHORS' CONCLUSIONS: Available evidence from included trials that compared neuraxial anaesthesia with general anaesthesia was insufficient to rule out clinically important differences for most clinical outcomes. Neuraxial anaesthesia may reduce pneumonia. No conclusions can be drawn with regard to mortality, myocardial infarction and rate of lower-limb amputation, or less common outcomes.

Neuraxial anaesthesia for lower-limb revascularization.

BACKGROUND: Lower-limb revascularization surgery is used to reduce pain and sometimes to improve lower-limb function. The type of anaesthesia used during lower-limb revascularization may affect the risks of both good and bad outcomes. OBJECTIVES: To determine the rates of death and major complications with spinal and epidural anaesthesia compared with other types of anaesthesia for lower-limb revascularization. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library 2008, Issue 2); MEDLINE (1960 to 10th June 2008); EMBASE (1982 to 10th June 2008); LILACS (1982 to 10th June 2008); CINAHL (1982 to 10th June 2008) and ISI Web of Science (1900 to 10th June 2008). SELECTION CRITERIA: We included randomized controlled trials that evaluated the effect of anaesthetic type in adults aged 18 years or older undergoing lower-limb revascularization surgery. DATA COLLECTION AND ANALYSIS: Two authors independently performed the data extraction. Primary outcomes were mortality, cerebral stroke, myocardial infarction, nerve dysfunction and postoperative lower-limb amputation rate. The secondary outcome analysed was pneumonia. We judged risk of bias with four criteria: randomization and allocation concealment methods, blinding of treatment and outcome assessment and completeness of follow up. To assess heterogeneity we used the I(2) statistic. We summarized dichotomous data as odds ratio (OR) with 95% confidence interval (CI) using a random-effects model. MAIN RESULTS: We included four studies that compared neuraxial anaesthesia with general anaesthesia. The total number of participants was 696, of whom 417 were allocated to neuraxial anaesthesia and 279 to general anaesthesia. Participants allocated to neuraxial anaesthesia had a mean age of 67 years and 59% were men. Participants allocated to general anaesthesia had a mean age of 67 years and 66% were men. There was no difference between participants allocated to neuraxial or general anaesthesia in: mortality rate (OR 0.89, 95% CI 0.38 to 2.07; 696 participants, four trials); myocardial infarction (OR 1.23, 95% CI 0.56 to 2.70; 696 participants, four trials); and lower-limb amputation rate (OR 0.84, 95% CI 0.38 to 1.84; 465 participants, three trials). Pneumonia was less common following neuraxial anaesthesia than general anaesthesia (OR 0.37, 95% CI 0.15 to 0.89; 201 participants, two trials). AUTHORS' CONCLUSIONS: There was insufficient evidence available from the included trials that compared neuraxial anaesthesia with general anaesthesia to rule out clinically important differences for most clinical outcomes. Neuraxial anaesthesia may reduce pneumonia. No conclusions can be drawn with regard to mortality, myocardial infarction and rate of lower-limb amputation or less common outcomes.

Induced abortion: risk factors for adolescent female students, a Brazilian study.

The purpose of this study was to analyze risk factors for abortion among female teenagers from 12 to 19 years of age in the city of Maceió, Brazil. This is a cross-sectional study, conducted in ten schools. The sample was calculated by considering the number of admissions for postabortion curettage, obtained from the Information System of Hospitalization. Data were obtained through a semi-structured questionnaire divided into three basic blocks of data: sociodemographic, sexual life, and pregnancy/abortion. To analyze the data, the logistic regression model was used. The Forward Method was chosen to set the final model that minimizes the number of variables and maximizes the accuracy of the model. The significant analysis between the dichotomous variables provided eight significant variables. Two of them are protective for abortion: the ages 12-14 years and talking with parents about sex. After the logistic regression, the receipt of support for abortion was the most significant variable of all. The adolescent with an active sexual life, a previous pregnancy, who is married, and has received support for an abortion has a 99.74% probability for an abortion. The results of this study, demonstrating the importance of the group in adolescence, and the statistical significance of having a partner to support and approve the pregnancy appears as a preventive factor for abortion. It shows the importance of support and companionship for adolescent women.

Adolescents: contraceptive knowledge and use, a Brazilian study.

The purpose of this study was to identify the knowledge and use of contraceptive methods by female adolescent students. The study was cross-sectional and quantitative, using a semi-structured questionnaire that was administered to 12- to 19-year-old female students in Maceió, Brazil. A representative and randomized sample was calculated, taking into account the number of hospital admissions for curettage. This study was approved by the Human Research Ethics Committee, and Epi Info software was used for data and result evaluation using the mean and chi-square statistical test. Our results show that the majority of students know of some contraceptive methods (95.5%), with the barrier/hormonal methods being the most mentioned (72.4%). Abortion and aborting drugs were inaccurately described as contraceptives, and 37.9% of the sexually active girls did not make use of any method. The barrier methods were the most used (35.85%). A significant association was found in the total sample (2,592) between pregnancy and the use of any contraceptive method. This association was not found, however, in the group having an active sexual life (559). The study points to a knowledge of contraceptive methods, especially by teenagers who have already been pregnant, but contraceptives were not adequately used. The low use of chemical methods of contraception brings the risk of pregnancy. Since abortion and aborting drugs were incorrectly cited as contraceptive methods, this implies a nonpreventive attitude towards pregnancy.

Short stature and food habits as determining factors for the low productivity of sugarcane labourers in the State of Alagoas, north-eastern Brazil.

Undernutrition, especially in the prenatal period and/or until 5 years of age, can cause stunting. Adults with short stature resultant from this process show a series of functional deficits, amongst which is a reduced capacity to do physical work. The aim of this investigation was to evaluate the dietary pattern, nutritional status and stature of sugarcane cutters, and to determine possible associations with worker productivity. Sixty-two male sugarcane cutters (18-50 y) were selected randomly from a population of 600 workers from a plantation in Alagoas (Brazil), and classified as underweight, normal weight or overweight according to BMI (BMI = 21.5, 21.5 to = 25 and >25 kg/m2, respectively). Body fat composition (%) was estimated by electrical bioimpedance and dietary intake by the direct weighing of food consumed. Whilst the average productivity was 8.13 ton/day, labourers with normal BMI values were more productive (9.12 ton/dia) and ingested significantly (p<0.05) greater amounts of energy (16506.4 kJ/dia) than their underweight (7.48 +/- 1.5; 12380.7 +/- 4184.1) or overweight (9.12 +/- 1.5; 16506.4 +/- 6360.0) counterparts, respectively. There were associations (p<0.05) between productivity, stature, energy intake and age. The tallest individuals (= 170 cm) had higher productivity and tended to have a higher energy intake, whilst those with the shortest stature (= 160 cm), had a significantly lower productivity, however ingested a similar quantity of energy, and tended to have a large accumulation of body fat. Multiple regression analysis identified stature as the parameter most associated with productivity, independent of age and body fat percentage. Productivity of the tallest individuals was 1.87 ton/day higher than that of the shortest individuals. The results emphasise the importance of good nutritional status throughout life for full development of working productivity.

Short stature and food habits as determining factors for the low productivity of sugarcane labourers in the State of Alagoas, north-eastern Brazil

Undernutrition, especially in the prenatal period and/or until 5 years of age, can cause stunting. Adults with short stature resultant from this process show a series of functional deficits. amongst which is a reduced capacity to do physical work. The aim of this investigationwas to evaluare the dietary pattern, nutritional status and stature of sugarcane cutters, and to determine possible associations with worker productivity. Sixty-two male sugarcane cutters (18-50 y) were selected randomly from a population of 600 workers from a plantation in Alagoas (Brazil), and classified as underweight, normal weight or overweight according to BMI (BMI =21.5, 21.5 to = 25 and >25 kg/m², respectively). Body fat composition (percent) was estimated by electrical biompedance and dietary intake by the direct weighing of food consumed. Whilist the average productivity was 8.13 ton/day,m labourers with normal BMI values were more productive (9.12 ton/day) and ingested significantly (p<0.05) greater amounts of energy (16506.4 kJ/dia) than their underweight (7.48 ± 1.5; 12380.7 ± 4184.1) or overweight (9.12 ± 1.5; 16506.4 ± 6360.0) counterparts, respectively. There were associations (p<0.05) between productivity, stature, energy intake and age. The tallest individuals (= 170 cm) had higher productivity and tended to have a higher energy intake, whilst those with the shortest stature (= 160 cm), had a significantly lower productivity, however ingested a similar quantity of energy, nd tented to have a large accumulation of body fat. Multiple regression analysis indetified stature as the parameter most associated with productivity, independent of age and body fat percentage. Productivity of the tallest individuals. The results emphasise the importance of good nutritional status throughghout life for full development of working productivity

Short stature, abdominal obesity, insulin resistance and alterations in lipid profile in very low-income women living in Maceió, north-eastern Brazil.

OBJECTIVE: To test the hypothesis that short stature is associated with abdominal obesity, insulin resistance and lipid profile changes. METHODS: Anthropometric data were collected from 237 women (18-60 years old), residents of a shantytown in Maceió. Biochemical profiles of 60 individuals drawn from this population were determined. RESULTS: Total and low-density lipoprotein (LDL) cholesterol levels and insulin resistance rose with increasing waist : hip circumference ratio, particularly in women. Short, overweight individuals exhibited larger biochemical alterations than overweight individuals of average stature. CONCLUSION: Short stature, when associated with overweight, is a risk factor for increased insulin resistance and alterations in lipid profile.

Fluoride intake from drinking water and dentifrice by children living in a tropical area of Brazil

OBJECTIVE: To assess fluoride (F-) intake from water and toothpaste by children aged 18 to 36 months and to monitor the F- concentrations in the drinking water system in a tropical city of Brazil. METHODS: Children (n=58) aged 18-36 months, all lifetime residents of Penedo, state of Alagoas, Brazil, participated in this study. Water F- analyses were carried out in 7 different occasions at least a week apart. For 2 days all the water drunk by each child was accounted for. Fluoride intake from water for each child was estimated using the mean F- concentration of water in 7 different occasions. Fluoride intake from toothpaste was estimated by subtracting the recovered post-brushing F- from the original amount placed in the toothbrush. The F- intake from water and toothpaste was estimated by dividing the total amount of F- ingested by the weight of each child. RESULTS: The mean F- concentration in the drinking water was 0.94 ppm (mean range 0.78-1.1 ppm), which is above the 0.7 ppm recommended for this area of Brazil. Mean total F- intake from water and toothpaste was 0.128 mg F-/Kg Body Weight/day. The daily means of F- intake from water and toothpaste were 0.021 and 0.107 mg F-/Kg Body Weight, respectively. Ninety six percent of children showed F- intake above 0.07 mg F-/Kg Body Weight/day. CONCLUSIONS: Children in Penedo are at risk for developing dental fluorosis due to high F- intake from fluoridated toothpastes. Water fluoridation showed low contribution to the total F- intake. However, high water F- concentrations in the water indicate the need of surveillance of the artificial water fluoridation system.

OBJETIVOS: determinar a ingestão de flúor (F-) pela água e creme dental em crianças de 18 a 36 meses de idade que moram em uma cidade de clima tropical no Brasil e monitorar as concentrações de F- no sistema de água potável. MATERIAIS MÉTODOS: participaram deste estudo crianças (n=58), 18-36 meses, todas residentes vitalícias de Penedo (Alagoas), Brasil. As análises de F- em amostras de água foram realizadas em 7 ocasiões diferentes em semanas separadas. Durante 2 dias toda a água bebida por cada criança foi considerada. A ingestão de fluoreto para cada criança foi calculada pela média de flúor na água nas 7 ocasiões diferentes. A ingestão de F- pelo creme dental foi calculada subtraindo a saliva recuperada do expectorado pela quantidade de F- colocada na escova dental. A ingestão de F- de água e pasta de dentes foi calculada dividindo a quantia de F ingerida pelo peso de cada criança. RESULTADOS: A concentração média de F- em água potável foi de 0,94 ppm (variando de 0.78-1.12 ppm) estando acima do recomendado para esta área do Brasil que é de 0,7 ppm. A ingestão de F- total (água + creme dental) foi de 0,128 mg de F/Kg peso/dia. As médias diárias de ingestão de F- pela água e creme dental foram de 0,021 e 0,107 mg F-/Kg de peso corporal dia, respectivamente. Noventa que seis por cento das crianças demonstraram ingestão de F- superior a 0,07 mg de F-/Kg peso/dia. CONCLUSÕES: crianças em Penedo estão sob risco de desenvolver fluorose dental devido a elevada ingestão de F- pelo creme dental fluoretado. Adição de flúor à água de água mostrou baixa contribuição ao flúor total ingerido. Porém, altas concentrações de F- na água indicam a necessidade de vigilância do sistema de fluoretação artificial das águas.

Fluoride intake from drinking water and dentifrice by children living in a tropical area of Brazil%Ingestão de flúor pela água e creme dental por crianças residentes de uma área de clima tropical do Brasil

OBJETIVOS: determinar a ingestão de flúor (F-) pela água e creme dental em crianças de 18 a 36 meses de idade que moram em uma cidade de clima tropical no Brasil e monitorar as concentrações de F- no sistema de água potável. MATERIAIS MÉTODOS: participaram deste estudo crianças (n=58), 18-36 meses, todas residentes vitalícias de Penedo (Alagoas), Brasil. As análises de F- em amostras de água foram realizadas em 7 ocasiões diferentes em semanas separadas. Durante 2 dias toda a água bebida por cada criança foi considerada. A ingestão de fluoreto para cada criança foi calculada pela média de flúor na água nas 7 ocasiões diferentes. A ingestão de F- pelo creme dental foi calculada subtraindo a saliva recuperada do expectorado pela quantidade de F- colocada na escova dental. A ingestão de F- de água e pasta de dentes foi calculada dividindo a quantia de F ingerida pelo peso de cada criança. RESULTADOS: A concentração média de F- em água potável foi de 0,94 ppm (variando de 0.78-1.12 ppm) estando acima do recomendado para esta área do Brasil que é de 0,7 ppm. A ingestão de F- total (água + creme dental) foi de 0,128 mg de F/Kg peso/dia. As médias diárias de ingestão de F- pela água e creme dental foram de 0,021 e 0,107 mg F-/Kg de peso corporal dia, respectivamente. Noventa que seis por cento das crianças demonstraram ingestão de F- superior a 0,07 mg de F-/Kg peso/dia. CONCLUSÕES: crianças em Penedo estão sob risco de desenvolver fluorose dental devido a elevada ingestão de F- pelo creme dental fluoretado. Adição de flúor à água de água mostrou baixa contribuição ao flúor total ingerido. Porém, altas concentrações de F- na água indicam a necessidade de vigilância do sistema de fluoretação artificial das águas.

Fluoride intake from drinking water and dentifrice by children living in a tropical area of Brazil.

OBJECTIVE: To assess fluoride (F-) intake from water and toothpaste by children aged 18 to 36 months and to monitor the F- concentrations in the drinking water system in a tropical city of Brazil. METHODS: Children (n=58) aged 18-36 months, all lifetime residents of Penedo, state of Alagoas, Brazil, participated in this study. Water F- analyses were carried out in 7 different occasions at least a week apart. For 2 days all the water drunk by each child was accounted for. Fluoride intake from water for each child was estimated using the mean F- concentration of water in 7 different occasions. Fluoride intake from toothpaste was estimated by subtracting the recovered post-brushing F- from the original amount placed in the toothbrush. The F- intake from water and toothpaste was estimated by dividing the total amount of F- ingested by the weight of each child. RESULTS: The mean F- concentration in the drinking water was 0.94 ppm (mean range 0.78-1.1 ppm), which is above the 0.7 ppm recommended for this area of Brazil. Mean total F- intake from water and toothpaste was 0.128 mg F-/Kg Body Weight/day. The daily means of F- intake from water and toothpaste were 0.021 and 0.107 mg F-/Kg Body Weight, respectively. Ninety six percent of children showed F- intake above 0.07 mg F-/Kg Body Weight/day. CONCLUSIONS: Children in Penedo are at risk for developing dental fluorosis due to high F- intake from fluoridated toothpastes. Water fluoridation showed low contribution to the total F- intake. However, high water F- concentrations in the water indicate the need of surveillance of the artificial water fluoridation system.